Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Can Dynamic Ultrasonography of the Hip Reliably Assess Anterior Femoral Head Translation?

d’Hemecourt, Pierre A., MD; Sugimoto, Dai, PhD; McKee-Proctor, Maxwell, BA; Zwicker, Rebecca L., MPH; Jackson, Sarah S., MD; Novais, Eduardo N., MD; Kim, Young-Jo, MD, PhD; Millis, Michael B., MD; Stracciolini, Andrea, MD

Clinical Orthopaedics and Related Research®: May 2019 - Volume 477 - Issue 5 - p 1086–1098
doi: 10.1097/CORR.0000000000000457
2018 BERNESE HIP SYMPOSIUM
Buy
SDC

Background Hip microinstability has gained attention recently as a potential cause of hip pain. Currently there is a lack of evidence-based objective diagnostic criteria surrounding this diagnosis. Previous studies have shown translation of the femoral head during extreme hip positions. However, reliable assessment of femoral head translation is lacking.

Questions/purposes (1) How precise is musculoskeletal ultrasound for measuring anterior femoral head translation during the hip anterior apprehension test? (2) What is the intra- and interrater reliability of dynamic ultrasonography in assessing anterior femoral head translation?

Methods We recruited 10 study participants (20 hips) between the ages of 22 and 50 years with no history of hip pain or functional limitations. Test-retest methodology was used. Seven females and three males were enrolled. The mean age of study participants was 27 years (SD 8.7 years); mean body mass index was 22.6 kg/m2 (SD 2.2 kg/m2). All study participants underwent dynamic hip ultrasonography by three different physicians 1 week apart. Each hip was visualized in two neutral positions (neutral and neutral with the contralateral hip flexed [NF]) and two dynamic positions, which sought to replicate the apprehension test, although notably study participants had no known hip pathology and therefore no apprehension. The first maintained the hip in extension and external rotation off to the side of the examination table (EER1), and the second held the hip off of the bottom of the examination table (EER2). One hundred twenty ultrasound scans (480 images) were performed. Mean and SD were calculated using absolute values of the difference in ultrasound measurements (mm) between positions NF and EER1 and NF and EER2 calculated for each physician as well as an average of all three physicians. Intraclass correlation coefficient (ICC) analysis was used to examine intra- and interrater reliability.

Results The mean absolute difference for NF and EER1 was 0.84 mm (SD 0.93 mm) and for NF and EER2 0.62 mm (SD 0.40 mm) on Study Day 1. Similarly, on Study Day 2, the mean absolute difference for NF and EER1 position was 0.90 mm (SD 0.74 mm) and for NF and EER2 1.03 mm (SD 1.18 mm). Cumulative values of ICC analysis indicated excellent intrarater reliability in all four positions: neutral 0.794 (95% confidence interval [CI], 0.494-0.918), NF 0.927 (95% CI, 0.814-0.971), EER1 0.929 (95% CI, 0.825-0.972), and EER2 0.945 (95% CI, 0.864-0.978). Similarly, interrater ICC analysis cumulative values were excellent for NF, EER1, and EER2 and fair to good for the neutral position: neutral 0.725 (95% CI, 0.526-0.846), NF 0.846 (95% CI, 0.741-0.913), EER1 0.812 (95% CI, 0.674-0.895), and EER2 0.794 (95% CI, 0.652-0.884).

Conclusions This study offers the first ultrasound protocol of which we are aware for measuring anterior femoral head translation. Hip dynamic ultrasound may assist in providing precise objective clinical-based diagnostic evidence when evaluating complex hip pain and suspected microinstability. Musculoskeletal ultrasound is a reliable office-based method of measuring anterior femoral head translation that can be utilized by physicians with varying experience levels. Future studies are needed to investigate ultrasound anterior femoral head translation taking into account sex, prior hip surgery, hip osseous morphology, and ligamentous laxity.

Level of Evidence Level III, diagnostic study.

P. A. d’Hemecourt, D. Sugimoto, M. McKee-Proctor, R. L. Zwicker, S. S. Jackson, A. Stracciolini, Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA, USA

P. A. d’Hemecourt, S. S. Jackson, E. N. Novais, Y.-J. Kim, M. B. Millis, A. Stracciolini, Department of Orthopaedics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

A. Stracciolini, Department of Medicine, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA

P. A. d’Hemecourt, D. Sugimoto, S. S. Jackson, E. N. Novais, Y.-J. Kim, M. B. Millis, A. Stracciolini, Harvard Medical School, Boston, MA, USA

P. A. d’Hemecourt, D. Sugimoto, S. S. Jackson, A. Stracciolini, The Micheli Center for Sports Injury Prevention, Waltham, MA, USA

A. Stracciolini, Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, 319 Longwood Avenue, Boston, MA 02115, USA, email: Andrea.stracciolini@childrens.harvard.edu

Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Boston Children’s Hospital, Waltham, MA, USA.

Received May 09, 2018

Accepted July 27, 2018

© 2019 Lippincott Williams & Wilkins LWW
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website